Achilles Tendon Pain: Causes, Symptoms and Treatment
Updated: Jul 8
If you're experiencing pain at the back of your heel or lower leg, your Achilles tendon may be the cause.
Achilles tendon pain is a common condition that affects people of all ages and activity levels. While it is often associated with runners and athletes, anyone can develop pain in the Achilles tendon, particularly if they spend a lot of time on their feet, suddenly increase their activity levels or have certain foot mechanics.
Fortunately, most cases of Achilles tendon pain improve with appropriate treatment and activity modification.
In this guide, we'll explain what the Achilles tendon is, why it becomes painful, how long recovery may take and when it may be worth seeking professional advice.
What Is the Achilles Tendon?
The Achilles tendon is the largest and strongest tendon in the human body.
It connects the calf muscles to the heel bone (calcaneus) and plays an important role in:
Walking
Running
Jumping
Climbing stairs
Standing on tiptoes
Every time you push off the ground, your Achilles tendon is working.
Because it is used so frequently, it is also vulnerable to injury and overuse.
What Is Achilles Tendon Pain?
Achilles tendon pain usually occurs when the tendon becomes irritated or overloaded.
You may hear healthcare professionals refer to this as:
Achilles tendinopathy
Achilles tendonitis
Achilles tendonitis
Achilles tendon degeneration
While "Achilles tendonitis" is a commonly used term, many long-standing cases involve changes within the tendon rather than simple inflammation.
What Does Achilles Tendon Pain Feel Like?
Symptoms vary from person to person but commonly include:
Pain at the back of the heel
Pain just above the heel bone
Stiffness first thing in the morning
Pain when walking uphill
Pain during or after exercise
Tenderness when touching the tendon
Swelling around the tendon
Many people notice that symptoms improve slightly once they start moving, only to worsen later in the day.
Why Does the Achilles Tendon Become Painful?
There is rarely a single cause.
Instead, Achilles tendon pain often develops when the tendon experiences more stress than it can comfortably tolerate.
Sudden Increases in Activity
One of the most common causes is doing too much too quickly.
Examples include:
Starting a new exercise programme
Increasing running distance
Returning to sport after a break
Walking significantly more than usual
Tight Calf Muscles
Limited flexibility in the calf muscles can increase strain on the Achilles tendon.
Foot Mechanics
The way your feet function during walking and running may affect the load placed on the tendon.
Examples include:
Flat feet
High arches
Overpronation
Reduced ankle mobility
Footwear Changes
Changing to different footwear, particularly shoes with less heel cushioning or support, may contribute to symptoms.
Age
The Achilles tendon naturally becomes less flexible with age, which may increase susceptibility to injury.
Where Is Achilles Tendon Pain Usually Felt?
Pain typically occurs in one of two locations.
Mid-portion Achilles Tendinopathy
This affects the tendon itself, usually around 2–6 centimetres above the heel bone.
Symptoms often include:
Pain during activity
Morning stiffness
Tenderness
Thickening of the tendon
Insertional Achilles Tendinopathy
This occurs where the tendon attaches to the heel bone.
People with insertional pain often experience:
Pain directly at the back of the heel
Discomfort when wearing certain shoes
Pain when walking uphill or climbing stairs
Can You Walk With Achilles Tendon Pain?
In many cases, yes.
However, continuing activities that significantly increase pain may delay recovery.
Walking that causes mild discomfort is often acceptable, but severe pain or limping should generally be avoided.
The goal is usually to maintain activity while avoiding excessive tendon overload.
How Is Achilles Tendon Pain Treated?
Relative Rest
Complete rest is rarely necessary.
Instead, reducing activities that significantly worsen symptoms may help.
Exercise is one of the most important treatments for Achilles tendon pain.
Appropriate strengthening exercises can help improve the tendon's ability to tolerate load.
Stretching
Stretching the calf muscles may improve flexibility and reduce strain.
Footwear
Supportive footwear can help reduce stress on the tendon.
Some people benefit from temporarily wearing shoes with a slightly higher heel.
Ice
Ice may help provide short-term symptom relief following activity.
Insoles and Orthotics
In some cases, insoles or orthotics may help redistribute pressure and improve foot function.
How Long Does Achilles Tendon Pain Last?
Recovery times vary considerably.
Mild Cases
A few weeks to three months
Moderate Cases
Three to six months
Long-Standing Cases
Six months or longer
The earlier treatment begins, the better the chances of a quicker recovery.
What Makes Achilles Tendon Pain Worse?
Common aggravating factors include:
Running
Sprinting
Walking uphill
Climbing stairs
Sudden increases in activity
Unsupportive footwear
Identifying and modifying aggravating activities often forms an important part of treatment.
When Should You See a Podiatrist?
You should seek professional advice if:
Pain persists for more than a few weeks.
Symptoms are worsening.
You are limping.
The pain is affecting work or exercise.
Home treatments are not helping.
You experience sudden severe pain or weakness.
Early assessment may help prevent symptoms becoming long-term.
Final Thoughts
Achilles tendon pain is a common cause of pain at the back of the heel and can affect people of all activity levels.
While symptoms can be frustrating and sometimes slow to improve, most cases respond well to conservative treatment and appropriate rehabilitation.
If your symptoms are persistent, worsening or affecting your daily life, seeking professional advice may help identify contributing factors and support your recovery.
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